Evaluation of selected morphological markers of inflammation in afterbirth from idiopathic premature labors

Abstract

Summary Objective: To evaluate morphological markers of inflammation in afterbirth tissue from idiopathic premature labors, with regard to symptoms of infection in newborns. Material and methods: Study group: 83 afterbirth specimens from spontaneous labors between 22 and 37 weeks gestation. Control group: 30 afterbirth specimens from physiological labors. The histopathological examination included evaluation of placenta with umbilical membranes and umbilical cords from the abovementioned labors; next the results were juxtaposed with the incidence of neonatal infections. The evaluation covered sensitivity, specificity, as well as the positive and negative predicative value of morphological markers in afterbirth infection as a diagnostic test for predicting the incidence of neonatal infections. Results: 1. Morphological markers of afterbirth inflammation were reported in 28.9% of women giving premature birth (p<0.05). 2. Features of afterbirth inflammation were most frequently observed in the fetal membranes, and in the fetal membranes and placenta. 3. Premature disruption of the fetal membranes occurred in 66.7% of women with morphological markers of afterbirth inflammation and in 23.7% of women giving premature birth with no features of afterbirth inflammation (p<0.05). 4. Neonatal infection was reported in 75% of labors with morphological markers of afterbirth inflammation and in 5.1% of labors with no features of afterbirth inflammation (p<0.05). 5. Usefulness of confirming afterbirth inflammation for diagnosing neonatal infections: sensitivity 85.7%, specificity 90.3%, positive predicative value 75%, negative predicative value 94.9%. Conclusion: 1. Afterbirth inflammation occurs in 28.9% of all premature labors; however, the percentage differs depending on gestational age, from 84.2 % in week 22-28 to 4.9% in week 33-37 of gestation. 2. Afterbirth inflammatory changes were reported in 2/3 of premature labors with premature disruption of the fetal membranes. 3. Identification of morphological markers of afterbirth inflammation has high sensitivity (85.7%) and specificity (90.3%) in predicting neonatal infections.